Year of Publication
Doctor of Nursing Practice
Dr. Sheila Melander
Dr. Linda Clements
Dr. Candice Falls
Background: Delayed enteral nutrition (EN) in critically ill patients increases the risk of complications and poor outcomes. The 2016 American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) and Society of Critical Care Medicine (S.C.C.M.) evidence-based guideline recommends initiating EN within 24-48 hours of Intensive Care Unit (ICU) admission once resuscitation and hemodynamically stability have been achieved. The evidence-based guideline notes that critically ill patients on low-dose vasopressors can be started on EN with close monitoring.
Purpose: This interprofessional project aims to increase the amount of EN delivered to all qualifying Cardiovascular Intensive Care Unit (CVICU) patients who are at risk for poor nutrition through the use of staff education, improved guideline compliance, dietary consultations, and chart audits.
Methods: A retrospective and prospective chart audit and pre-and-post-nursing survey to determine overall nutritional intake via EN in CVICU patients with vasopressor agents. The CVICU nurses will complete a pre-test via Redcaps, receive digital education (voiceover PowerPoint), and then a post-test via Redcap’s survey software. Retrospective institutional data (chart audit) will be collected to compare the total volume of EN received in the eligible population within 48 hours of vasopressor initiation at baseline (pre-education) compared to after-education intervention. The chart audit will also review the coordination of nutrition care between the critical care team, as evidenced by increasing nutrition consult orders within 24 hours of vasopressor initiation.
Results: There was a significant improvement in confidence level using the University of Kentucky Healthcare (UKHC) EN feeding guideline (p-value < .001). Most respondents 3 considered their EN knowledge average/above average in pre and post-test (86.8% and 92%). Although 86.8% of participants had considered their EN knowledge average/above average in the pretest, respondents reported a knowledge deficit (less than 25% correct) in the pretest about the timing of EN, differentiating between high-risk vasopressor dose when on multiple pressors, tube feed formula, signs and symptoms of feeding intolerance, and clinical evidence required to initiate EN. Only 22% (n=9) of patients in the pre-intervention chart review and 37.5% (n=15) of patients in the post-intervention chart review were started on EN within less than 48 hours of vasopressors being ordered. Therefore, initiating EN within 48 hours of vasopressors being ordered (p-value 0.125) or increasing the number of nutrition consult orders (p-value 0.325) and nutrition evaluation (p-value 0.381) was not statistically significant.
Conclusion: There is still a gap in initiating EN therapy within 48 hours of vasopressors. However, more education and a larger sample size can better understate guideline compliance. This study demonstrated the positive impact of a multifaceted educational approach on nursing knowledge and attitudes. Despite the established guideline, it highlighted some challenges and gaps associated with EN in the ICU.
Shah, Priyanka, "An Interprofessional Collaboration to Increase Total Enteral Nutrition in Critically Ill Patients on Vasopressor Agents in CVICU" (2023). DNP Projects. 420.